Finding Access

By Kylee sapp

Suzanne Sheridan, chief executive officer of the Rockbridge Area Health Center, said hiring a permanent women’s health specialist had been a priority since the “traumatic” loss of a permanent OB-GYN in 2010.

Kimary Schatten, hired in January,is only at the practice three days a week, because the practice is still growing. Sheridan said she hopes to expand the service to five days a weekin the future.

But already, Schatten’s presence is having an impact. Mary Looney, the chief operating officer of the Rockbridge Area Health Center, said there’s been an increase in women wanting to see the specialist.

“Where before, people may come here for their regular care, but they went somewhere else for their pap smear and their mammogram, they’re just staying here,” she said. “So it’s all under one roof. Which I think women like.”

Since it hired Schatten, the Rockbridge Area Health Center has added general women’s health care to its list of services, including Long Acting Reversible Contraceptives, like IUDs and implants

Mary Kuhar, the health nurse manager at ComfortCare Women’s Health, a clinic in Lexington, said some women have trouble obtaining prenatal care because it can be expensive.

ComfortCare tries to alleviate some of the financial burden for women. Not technically an OB-GYN, ComfortCare catches women at the first stage of an unplanned pregnancy. It performs pregnancy tests, ultrasounds and refers patients to other doctors who can get them into prenatal care. And its services are free.

Holly Zickefoose, director of patient services and community education at ComfortCare, said what sets the clinic apart from traditional OB-GYNs is the ability to listen to and talk with patients for as long as necessary.

ComfortCare also has a materials assistance program, called Patchwork, for moms-to-be.

“We provide enrichment workshops once a week, so they can come to a class for free,” Zickefoose said. “And we are able to help them with materials that they might need, like diapers and formula and stuff like that.”

Kuhar said although ComfortCare wants to continue to expand its services, it probably won’t be able to provide full prenatal care.

The Rockbridge Area Health Center uses a sliding scale system tied to the federal poverty line, which reduces co-pays for low-income and underinsured women. For example, a family of four with an annual income of $49,200 or less would qualify for a discount. Co-pays under the sliding scale can be anywhere from $22 to $55. This can greatly reduce the cost of prenatal care.

Sheridan said it’s difficult for a low-income family to qualify for Medicaid in Virginia because the General Assembly chose not to expand the program. But there are some exceptions.

“There are some areas where you can get Medicaid, and one of them is for if you’re pregnant,” she said. “Once you become pregnant, if you are not insured, the pathway to get Medicaid coverage is really pretty simple.”

By the end of the year, the Rockbridge Area Health Center will also be able to add telehealth services. This would allow women with high-risk pregnancies to talk to a doctor at the University of Virginia in Charlottesville from an exam room at the health center.

“It’s kind of like a high-speed Skype system,” Looney said.

It’s exactly like a regular doctor’s visit, except a nurse at the health center would be performing the physical part of the exam. This will eliminate the need for women to drive to Charlottesville for every appointment.

Sheridan said telehealth services are becoming more common in rural communities across the country to compensate for a lack of doctors.

Despite the number of OB-GYN providers in the area, none are full-time. Augusta Health Care for Women has an OB-GYN doctor on site three days a week, and the Women’s Center is open on Wednesdays.

Sarah Mae Selnick, a junior at Washington and Lee University, said she couldn’t get an appointment at the Augusta Health office in Lexington when she needed to. She drove to Augusta Health in Fishersville for both of her IUD appointments.

Karen Clark, the president of Augusta Medical Group, said it would be difficult for a permanent OB-GYN to start a practice in the area without the backing of a major health corporation, like Carilion or Augusta. Independent doctors don’t always have the resources to pay for facilities and equipment needed in a private practice.

Clark said Augusta Medical Group hasn’t considered putting a permanent OB-GYN in Lexington.

ComfortCare is also open only three days a week.Kuhar said the facility’s hours are “weird” on the days they are open because they recognize not all women can get to the doctor during regular business hours.

“We try to get people where they are [in their schedule],” she said. For example, on Tuesday mornings the clinic opens at 9:30 a.m. On Thursdays, it doesn’t open until 5:30 p.m., but stays open until 8.

The extended hours means that women won’t have to take off work to keep their appointments, which many low-income women cannot afford to do.

Transportation in a rural area

One of the biggest problems women in rural areas face is transportation to their doctors.

“If you’re a low-income woman and maybe you’re working, you probably don’t have a lot of time off,” said Sheridan, the Rockbridge Area Health Center CEO. “And are you able to drive, you know, an hour each way, and then however long it takes for the appointment.”

Kuhar said that although the OB-GYN options in Lexington are limited, at least they exist here.

“At least they don’t have to drive an hour for every single visit,” she said. “Because transportation for some of our people is [a] huge [problem]. Like, they have to cancel their appointment because: ‘I don’t have a ride today.’”

Most of the health care services that do exist in the county are based in Lexington or Buena Vista, meaning that residents who live outside of the two cities could be facing quite the drive. Goshen, for example, is 40 minutes away from Lexington.

Transportation is consistently cited as a barrier to accessing health care, according to survey results from the last several years of the Rockbridge Community Health Needs Assessment.

About 6.3 percent of Rockbridge County residents don’t own a car, according to the 2015 assessment. This means that they have to rely on friends or other family members for transportation to the doctor. They risk becoming a burden, and have to make their appointments around their ride’s schedule.

But patients who need to see specialists out of county may face more problems. In Lexington and Buena Vista, the percentage of households without a car is higher than the county: 10.1 percent of households in Buena Vista and 11.8 percent in Lexington don’t have a vehicle, according to the 2015 assessment.

There alsoare a few public transportation options available to residents.

The Rockbridge Area Health Center is on the route of the Maury Express, Lexington and Buena Vista’s low-cost public transportation system. A one-way ride costs 50 cents. Sheridan said that since the Maury Express has been running, the health center has seen business pick up.

But it’s not a perfect solution. Although the bus makes frequent stops around the two cities, it doesn’t venture into the county. Even people who live on the route don’t always know how to use it, like one resident who was having trouble making her appointments at the health center.

Sheridan said they talked to the patient about taking the Maury Express.

“She was afraid,” Sheridan said. “She couldn’t read well, and she was just afraid she wasn’t going to know how to get off at her stop.”

For county residents, the Rockbridge Area Transportation System, or R.A.T.S., is an option. R.A.T.S. is a door-to-door transport system that operates on a reservation basis.

Executive Director Betty LaRock said most of the R.A.T.S. user base doesn’t pay full price. She estimated that 75 percent to 80 percent of people are on Medicaid and ride for free to their doctors’ offices thanks to LogistiCare, a provider of non-emergency transportation programs.

Medicaid residents call and schedule appointments through LogistiCare, which then provides R.A.T.S. with a list of who needs to go where. R.A.T.S. then bills LogistiCare for the services.

For those not on Medicaid, R.A.T.S. also offers an informal sliding-scale payment system. The full cost of a ride is $2 per mile for the first 30 miles, $1.75 for miles 31 through 59, and then it continues to decrease. But LaRock said she has grant money she can use to help reduce the cost for the elderly, disabled or veterans.

The Rockbridge Area Health Center and R.A.T.S. have a voucher system for rides to and from the health center and to referrals out of town. The health center determines which patients need assistance with transportation both to appointments at the center itself and to specialists out of town. Then the health center covers part of the cost of transportation, and R.A.T.S. covers the rest through grants.

Sheridan said the loss of a permanent OB-GYN had a negative effect on the community. “It has been quite some time, and the community has adjusted,” she said. “You adapt.”